Pneumonia

Question 1

Pneumonia

What do we commonly use to assess severity?

Answer 1

CRB-65
CURB-65

the U is only used in hospital settings

Question 2

Pneumonia

What investigations do we usually do in the community?

Answer 2

basic obs

Question 3

Pneumonia

What might be found on an X-ray?

Answer 3

consolidation
(usually lower lobes)

Question 4

Pneumonia

What bloods are useful to take and why?

Answer 4

FBC, U&Es, LFTs, CRP

(severe infection)

Question 5

Pneumonia

What microbiological investigations might be done?

Answer 5

• Blood cultures
• Sputum culture and sensitivity
• Investigations for atypical bacteria and pathogens

Question 6

Pneumonia

What are some atypical pathogens?

Answer 6

Legionella pneumophila.
Mycoplasma pneumoniae.
Chlamydophila pneumoniae.

Question 7

Pneumonia

What are the 4 top CAP pathogens?

Answer 7

• Streptococcus pneumoniae
• influenza A
• Mycoplasma pneumoniae
• Chlamydophila pneumoniae

Question 8

Pneumonia

What are the top HAP pathogens?

2

Answer 8

• gram negative enterobacteria
• staph aureus

Question 9

Pneumonia

ABx should be used for treatment, but the choice of which should be guided by local protocols.

Examples include:

Answer 9

Question 10

Pneumonia

General management (non-prescribing).

Answer 10

Oxygen for hypoxia.
Fluids if dehydrated.

Question 11

Pneumonia

When is follow-up recommended for?

Answer 11

6 weeks

Question 12

Pneumonia

When should you order a CXR?

Answer 12

appropriate in cases of persisting signs and symptoms or if there is a high risk of underlying lung pathology

Question 13

Pneumonia

What vaccinations should be offered to high risk pts and those over 65y?

Answer 13

Influenza vaccination and pneumococcal vaccination

Question 14

Pneumonia

What is the definition of HAP?

Answer 14

‘pneumonia that develops 48 hours or more after hospital admission, and that was not incubating at hospital admission

Question 15

Pneumonia

What is the highest risk for HAP?

Answer 15

mechanical ventilation

Question 16

Pneumonia

Name 5 gram-negative bacteria often causative of HAP?

Answer 16

Question 17

Pneumonia

Name 2 gram-positive bacteria often causative of HAP?

Answer 17

Question 18

Pneumonia

Name some symptoms of HAP.

9

Answer 18

• Fever
• Rigor
• Malaise
• Anorexia
• Dyspnoea
• Cough
• Purulent sputum
• Haemoptysis
• Pleuritic chest pain

Question 19

Pneumonia

Name some signs of HAP.

8

Answer 19

• Pyrexia
• Cyanosis
• Confusion
• Tachypnoea
• Tachycardia
• Hypotension
• Signs of consolidation
• Pleural rub

the elderly may also be hypothermic, not pyrexial
confusions may be the only sign in the elderly

Question 20

Pneumonia

Name some signs of consolidation.

4

Answer 20

• diminished expansion
• dull percussion note
• increased tactile vocal fremitus/vocal resonance
• bronchial breathing

Question 21

Pneumonia

What are the risk factors for HAP?

7

Answer 21

• Poor infection control/hand hygiene (of treating healthcare workers)
• Head of bed at <30° angle
• Intubation and mechanical ventilation; endotracheal cuff pressure <20cm H2O
• H2 antagonist and antacid use
• Poor oral hygiene
• No interruption in sedation
• Reintubation

Question 22

Pneumonia

What are the 1st line investigations for HAP?

Answer 22

• Chest X-ray
• CT scanning
• WBC count with differential
• Pulse Oximetry
• Sputum Sample

Question 23

Pneumonia

What other investigations might we do for HAP after 1st line?

Answer 23

• Arterial Blood Gas
• CT chest

Question 24

Pneumonia

Which view is prefered in CXR?

Answer 24

PA and lateral views are preferred over AP

Question 25

# Pneumonia Why might a CT be ordered?

Answer 25

to diagnose an opacity and clarify whether a procedure is indicated

Question 26

# Pneumonia What are some risk factors for MDR pathogens? | multidrug-resistant (MDR) pathogens

Answer 26

* ABx in the past 90 days * Septic shock at the time of ventilator-associated pneumonia * ARDS preceding ventilator-associated pneumonia * >5 days hospitalisation prior to the occurrence of ventilator-associated pneumonia * Acute renal replacement therapy prior to ventilator-associated pneumonia

Question 27

# Pneumonia NICE guildlines for ABx prescription in over 18s. - 1st choice oral, non-severe clinical features, not at high risk of resistance | with and without penicillin allergy

Answer 27

- Co-amoxiclav (allergy) - Doxycycline, Co-trimoxazole, Levofloxacin

Question 28

# Pneumonia NICE guildlines for ABx prescription in over 18s. - 1st choice severe symptoms or signs (e.g. those of sepsis) or if the patient is at a higher risk of resistance

Answer 28

Piperacillin + tazobactam is recommended alternative: ceftriaxone

Question 29

# Pneumonia NICE guildlines for ABx prescription in over 18s. - 1st choice if the patient has a suspected or confirmed MRSA infection, then ____ is recommended. **For example...**

Answer 29

**dual IV therapy** Piperacillin / Ceftriaxone + Vancomycin / Teicoplanin / Linezolid

Question 30

# Pneumonia What management is indicated indicated in cases of respiratory failure, where non-invasive ventilation fails to maintain adequate oxygenation?

Answer 30

Intubation and invasive ventilation

Question 31

# Pneumonia When might a bronchoscopy or a thoracentesis need to be performed?

Answer 31

the patient is not recovering despite treatment and where an alternative diagnosis is being sought

Question 32

# Pneumonia What is Bronchopneumonia?

Answer 32

a subtype of pneumonia characterised by inflammation of the bronchi, bronchioles and alveoli.

Question 33

# Pneumonia What is broncho pneumonia aka and why?

Answer 33

lobular pneumonia Inflammatory patchy consolidations may be present in lobules, mainly in a basal location in the lungs

Question 34

# Pneumonia Name the pathogen: ____ is a gram-negative bacillus, often responsible for pneumonia in heavy alcoholics and causes cavitating lesions in the lungs.

Answer 34

Klebsiella pneumoniae

Question 35

# Pneumonia Name the pathogen: ____ is a gram-positive coccus responsible for bacterial pneumonia in the general population. It usually causes lobar pneumonia and is not typically associated with cavitating lesions.

Answer 35

Streptococcus pneumoniae

Question 36

# Pneumonia Name the pathogen: ____ is a gram-negative bacillus commonly implicated in infective exacerbations of chronic obstructive pulmonary disease. It is often associated with smoking, but is not typically associated with cavitating lesions.

Answer 36

Haemophilus influenzae

Question 37

# Pneumonia Name the pathogen: ____ is a gram-negative bacillus that causes atypical pneumonia, specifically called ____ disease. Classically, it presents following exposure to contaminated droplets *e.g. in poorly maintained air-conditioning systems*. Other characteristic features include hyponatraemia and deranged LFTs.

Answer 37

Legionella pneumophila Legionnaires disease. ## Footnote Diagnosis is usually with urinary legionella antigen detection.

Question 38

# Pneumonia Name the pathogen: ____ is a fungi-like bacteria that causes atypical pneumonia with dry cough. Characteristic features include erythema multiforme (a target-shaped lesion) and cold-agglutinin disease.

Answer 38

Mycoplasma pneumoniae ## Footnote Diagnosis is with mycoplasma serology tests.